“It’s Not Based on Scientific Data”: The Antiabortion Movement Is No Longer Hiding Its Extremism

In 2019, Ohio state representative John Becker made news for introducing legislation that would have allowed insurance companies to cover a “procedure for an ectopic pregnancy, that is intended to reimplant the fertilized ovum into the pregnant woman’s uterus.” The bill failed, but as far as many gynecologists knew, such a procedure had never been attempted let alone succeeded. The claim’s source seems to be two case reports of “tubal embryo successfully transferred in utero,” one published in 1917, one in 1990. Both accounts are rarely cited in medical research but have been cited by antiabortion theological bioethicists. A third report published in the British Journal of Obstetrics and Gynaecology in 1994 was later proven to be a hoax.

In 2021, Texas enshrined a version of Francis’s bioethical argument into their abortion law, and because of a December Supreme Court decision not to stay the law, it has now been in effect for almost 11 months. Despite the carve out in line with antiabortion thinking, it is already proving to be confusing at best and unworkable at worst. A recent study in The New England Journal of Medicine found that in the months since the state’s six-week ban went into effect, Texan patients experiencing pregnancy complications were already seeing painful and potentially life-threatening delays in care.

Ziegler points out that many of these bills, including the Texas law, were passed as messaging bills before it was clear how far the Supreme Court would go in the Dobbs case. In other words, these laws might not have been passed with enforcement in mind. Now eight abortion bans are in effect.

Earlier this month, the Associated Press told the story of Jessian Munoz, MD, an ob-gyn in San Antonio who saw a patient in the early stages of miscarriage. Because the fetus still had cardiac activity, an immediate abortion was illegal. The woman’s health deteriorated, and by the time the cardiac activity stopped 24 hours later, she required surgery, lost liters of blood, and had to be placed on a breathing machine. It’s not an isolated instance; in a report from the American Journal of Obstetrics and Gynecology, a group of doctors observed outcomes for 28 patients being treated at two Dallas County hospitals for dangerous pregnancies, and who were less than 22 weeks pregnant, finding that nine days passed before each patient’s illness was considered life-threatening, greatly increasing the chance of a bad outcome.

Even before Dobbs, hospitals were extremely risk-averse about abortion laws. In the 1990s, one of the antiabortion movement’s most successful initiatives was using malpractice suits to increase the costs of providing abortion care and drive doctors out of the business. According to a Guttmacher Institute survey of ob-gyns published in 2017, 93% of respondants hadn’t performed abortions in their practices in 2013 and 2014. In addition, 35% of the doctors surveyed would not provide patient referrals to an abortion provider, though only 16% of those practitioners said it was due to moral opposition. With Roe overturned, this anxiety has only compounded; some of the trigger bans coming into effect across the country have extremely high criminal penalties for people who perform abortions. Alabama has one of the most draconian laws, calling for a sentence of 10 to 99 years for an abortion conviction.

Limited emergency exceptions in the laws complicate things further. Daniel Grossman, MD, an ob-gyn who is the director of Advancing New Standards in Reproductive Health, a research group at the University of California San Francisco, points out that there is necessarily a degree of uncertainty when it comes to diagnosing and treating life-threatening pregnancy complications.

“Sometimes the diagnosis is not entirely clear,” he said in a recent interview. Take an ectopic pregnancy, for example.The standard of care where he practices is often to give the patient methotrexate, medication that would end the pregnancy. “We may not be 100% sure that the pregnancy is not in the uterus, and so there may be a tiny chance that that methotrexate is actually ending a pregnancy that’s inside the uterus.”

A study published in 2011 in Women’s Health Issues found that some Catholic hospitals ban the use of methotrexate in such a situation, believing it to be a “direct” abortion. As the study notes, without methotrexate, other options would be to wait until the fallopian tube ruptures, or to surgically remove the tube, putting the patient at higher risk of heavy bleeding or loss of fertility. An intervention that seems sufficient in a religious setting will inevitably feel cruel or even unethical when neither doctor nor patient is a believer.

In the wake of the Dobbs decision, the medical establishment has become more strident. When the decision came down on June 24, the American Medical Association released a statement promising to stay committed “committed to its longtime opposition to criminalizing medical practice.” Last Tuesday, the organization’s president, Jack Resneck Jr., also testified in front of Congress, where he said “we firmly and unequivocally support patients’ access to the full spectrum of reproductive health care options, including abortion, as a right.”

The antiabortion misinformation campaign already has its next targets. Mary Jacobson, MD, an ob-gyn and the chief medical officer of telemedicine start-up Alpha Medical, is seeing the same campaigns against hormonal contraceptives and the morning-after pill. There’s growing “misinformation about them being ‘abortifacient,’ which is completely false,” she says. “It’s not based on clinical and scientific data.” Still, lawmakers in Missouri voted last year to ban public funding for emergency contraception and intrauterine devices. The bill was ultimately set aside, but some lawmakers had signaled they would revisit if Roe was overturned.

Greer Donley, a professor at the University Pittsburgh Law School, is already anticipating a deluge of lawsuits. “It has to happen to protect patients, but these doctors, they’re in a terrible position,” she says. “So, the unfortunate reality is, who would want to be an ob-gyn right now, in the United States?”